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Dr Zelenko on Israel National News, May 21, 2020 — forthcoming paper ~ two weeks?

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Dr Zelenko expects to be in publication along with some German colleagues, in about two weeks. In the following video (pardon quality issues):

. . . he asks, in effect, isn’t it standard to treat a disease as early as possible, so why the strange difference here? He makes a comparison to how a fire can flash over into a much more dangerous stage and notes how much easier it is to hit it while it is small. He expresses a measure of anger with medical and political establishments, /do allow for that.

He identifies that by the time people are at a Doctor’s office they are likely to be about day 5 in the disease process, on the verge of an explosion in viral load with attendant damage to the body.

He estimates turnaround time at about 3 days on tests, thus if you wait you likely have had serious damage due to explosion in viral load with attendant cell destruction to produce those viruses; linked doubtless, is immune response which can spin out of control in a potentially fatal cytokine storm.

He points to manageable toxicity and safety then suggests, go on the drug cocktail, then pull back if there is no need.

An implication of his discussion is what we may call the U-model of such a disease as this. As came up in a current UD thread:

The idea is that a fast-mover disease like this triggers a U-shaped trend (with a potentially catastrophic descending arm), where the crisis is the bend. Those who fail to make it, unfortunately die . . . a reverse J as the rising arm has been frustrated. Recovery then takes an onward period so recovery statistics lag death statistics, part of the epidemiologist’s headaches. Of course, relapses can move us to a W . . . double U . . . etc. So, we have a simple descriptive model of the trend of such an illness. [This is similar to the plucking model of recession in economics.] The stitch in time factor is, to hit the process early in the descending arm, so the U is shallow; you will probably recall the question of building up one’s “resistance” to colds, Flu and the like. In the context of Ivermectin, its preliminary indication is that it can help to pluck back up from further down the descending arm. And of course hospitalisation is an index of being fairly far down the arm, ICU being a yet worse sign. Intubation and Ventilation are grim signs.

While we wait on his announced publication, we may wish to discuss. END

PS: An interesting second vid comes from India, courtesy Tech for Luddites:

https://www.youtube.com/watch?v=H8HtWHAr9rI

PPS: Here is the screen clip, June 3rd:

Comments
F/N: Lancet retracts the study that was blazed across headlines and used to stigmatise HCQ as deadly to patients, leading to declarations by WHO etc. As such, this updates 187 above on the audit on the article, it could not be completed. Hence, the retraction. Statement: https://www.thelancet.com/lancet/article/s0140673620313246 >>Statement from The Lancet Today, three of the authors of the paper, "Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis", have retracted their study. They were unable to complete an independent audit of the data underpinning their analysis. As a result, they have concluded that they "can no longer vouch for the veracity of the primary data sources." The Lancet takes issues of scientific integrity extremely seriously, and there are many outstanding questions about Surgisphere and the data that were allegedly included in this study. Following guidelines from the Committee on Publication Ethics (COPE) and International Committee of Medical Journal Editors (ICMJE), institutional reviews of Surgisphere’s research collaborations are urgently needed. The retraction notice is published today, June 4, 2020. The article will be updated to reflect this retraction shortly.>> HT, BA77 for a heads up. This is saddening, given the issues of lives on the line and obvious atmosphere-poisoning effect. How did this ever pass peer review? KFkairosfocus
June 4, 2020
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Over 20 more schools were closed Thursday due to coronavirus infections, as Israel recorded the largest single day rise in coronavirus infections in over a month. According to the Education Ministry, 87 schools and daycares have now been closed to stem the spread of the virus, up from 65 earlier in the day. The ministry said 301 students and teachers have tested positive for COVID-19 during the fresh outbreak, with another 13,696 people in quarantine because of potential exposure to the virus. https://www.timesofisrael.com/over-20-more-schools-closed-as-israel-sees-largest-daily-virus-rise-in-a-month/rhampton7
June 4, 2020
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Interview with Matthew F. Pullen, MD, infectious diseases and international medicine physician at the University of Minnesota and one of the investigators on the recent hydroxychloroquine prophylaxis trial (above) Contagion®: Was your team surprised by the results? Pullen: I think, throughout the process, most of us had kind of mixed feelings. We weren't sure how it was going to pan out, especially as some of these observational studies started coming in, some positive, some negative. With a lot of them, it's hard to really tell what to make of the data due to the inherent issues with observational studies, and then some of the issues within those studies themselves. So seeing that kind of mixed bag of results from other studies made us feel like each outcome was probably equally likely. But it was nice to get a pretty solid answer rather than something that was borderline. https://www.contagionlive.com/news/hydroxychloroquine-as-postexposure-prophylaxis-for-covid19-clinical-takeawaysrhampton7
June 4, 2020
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Authors Retract Study That Found Risks of Using Antimalaria Drug Against Covid-19 Three authors involved in Lancet article that drew scrutiny said they couldn’t get full data set behind study - June 4, 2020 3:51 pm https://www.wsj.com/articles/authors-retract-study-that-found-risks-of-using-antimalaria-drug-against-covid-19-11591299329bornagain77
June 4, 2020
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If you make a crooked yardstick your standard of upright, straight and accurate you will systematically reject what is truly such.
Indeed.Bob O'H
June 4, 2020
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More than one-third of patients with lupus have experienced significant issues filling their hydroxychloroquine prescription during the COVID-19 pandemic, according to the results of a survey released May 28 by the Lupus Research Alliance. The Lupus Research Alliance conducted an online survey (May 6 to 18) to better understand the impact of the COVID-19 pandemic on the ability of people with lupus to continue treatment with hydroxychloroquine. In total, 334 responses were completed from patients in 42 states, with 63 percent reporting having taken hydroxychloroquine for more than five years (mean, 11.4 years). https://www.physiciansweekly.com/one-third-of-lupus-patients-have-trouble-refilling-hydroxychloroquine-2/rhampton7
June 4, 2020
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Most readers will have heard that this paper appeared in the NEJM late yesterday afternoon: it’s something that we haven’t had so far, an actual randomized, double-blinded, placebo-controlled hydroxychloroquine trial. This one was for post-exposure prophylaxis, a mode of treatment made famous by President Trump when he stated several times that he was taking the drug after people in the White House had tested positive. Tthere was no statistical difference in infection rate between the HCQ group and the placebo group. On the plus side, no arrhythmias were known to develop in the former (albeit without ECG monitoring, so it would have had to have been severe), and dropout rates were basically identical in the two groups. Side effects were more common in the treatment group, generally GI discomfort. For those who are wondering, there were smaller numbers of people in both groups who were taking zinc supplements, and there was no difference between them, either. So this trial was negative, although one should remember that it could have missed asymptomatic cases. It also tended to enroll relatively healthy people, and can’t speak to any possible protection of high-risk groups. You may also disagree with the initial design to detect 50% reduction in infections, although the HCQ fans would likely have expected at least that much. But within those limits, it provides no evidence that there is a prophylactic effect. From what I can see, the biggest evidence to the contrary is this retrospective analysis from the Indian Council of Medical Research looking at health care workers in that country taking prophylactic doses of HCQ, which found a significant risk reduction. That’s not a controlled trial, of course (and its authors conclude with a statement beginning “Until results of clinical trials for HCQ prophylaxis become available. . .”), but it is worth taking into account. The arguing will continue. https://blogs.sciencemag.org/pipeline/archives/2020/06/04/hydroxychloroquine-for-avoiding-infectionrhampton7
June 4, 2020
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More on Lancet: https://news.yahoo.com/lancet-casts-doubt-over-hydroxychloroquine-study-130453194.html >>The Lancet casts doubt over hydroxychloroquine study [AFP Relax News] AFP Relax News•June 3, 2020 The Lancet has issued an "expression of concern" over a large-scale study of hydroxychloroquine and chloroquine it recently published. The Lancet has issued an "expression of concern" over a large-scale study of hydroxychloroquine and chloroquine it published that led to the World Health Organization suspending clinical trials of the anti-viral drugs as a potential treatment for COVID-19. In a statement, the medical journal acknowledged "important" questions over the research, after dozens of scientists issued an open letter last week raising concerns about its methodology and transparency around the data, which was provided by the firm Surgisphere. "Although an independent audit of the provenance and validity of the data has been commissioned by the authors not affiliated with Surgisphere and is ongoing, with results expected very shortly, we are issuing an Expression of Concern to alert readers to the fact that serious scientific questions have been brought to our attention," The Lancet said Tuesday. While an expression of concern is not as severe as a journal withdrawing a published study, it signifies that the research is potentially problematic. >> This was peer reviewed and was used to drive policy, not to mention to try to do a reputation kill? KFkairosfocus
June 4, 2020
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EG, immediately as we see resort to placebo control exercises in the face of such a fast moving, fatal disease, we have solid reason to question the prudence, ethics and logical soundness of relevant experimenters and decision-makers. They have failed the first duties of reason standard at the outset, at design phase. Duties, to truth, right reason, prudence, sound conscience, neighbour [life! safety! tort!], fairness, justice, etc. This, for reasons explained many times and as the Kennedy School of Government paper again excerpted in 148 above summarises. So, we have little reason to trust credibility or soundness of analysis going forward. Indeed, on track record, it seems that there are systematic biases that build in failures and improper -- on epistemology, inductive logic and evidence grounds -- locking out of material factors and facts. This, with life on the line in an existential crisis. If you make a crooked yardstick your standard of upright, straight and accurate you will systematically reject what is truly such. In this context, kindly note from 178 -- rather than drown out -- the evasive backing off that WHO just had to do. They obviously faced a firestorm of behind the scenes protests, but instead of admitting the flaws in what they did, they have resorted to oh we met and decided to proceed with . . . obviously deeply flawed, likely biased and untrustworthy . . . trials. Lack of straightforwardness is the key governance failure sign as to what is going on. KF PS: In the end, it is clear that the albatross around our collective necks is the utterly corrosive effect of enabling the ongoing holocaust of our living posterity in the womb, currently at a bit under a million further victims per week and amounting to 800+ millions in 40+ years. The morally broken heart is deceitful, desperately wicked and beyond merely human cure. That's why Colson was so prone to remind us of how Solzhenitsyn warned that the line between good and evil passes through the individual human heart.kairosfocus
June 4, 2020
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Could it be possible that there is data showing reasonable effectiveness of HCQ against covid-19 and data showing no effectiveness? Yes. And if you understand how HCQ affects the body such that it helps prevent the lungs from becoming infected, you would understand why that could be the case. I wonder if anyone is monitoring the patients' pH levels?ET
June 3, 2020
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KF
EG, there is enough data to show reasonable effectiveness.
Except for all of the data showing no effectiveness.Ed George
June 3, 2020
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Randomized, double-blind, placebo-controlled trial (the gold standard) was not effective at preventing COVID-19 in high risk subjects.
We enrolled 821 asymptomatic participants. Overall, 87.6% of the participants (719 of 821) reported a high-risk exposure to a confirmed Covid-19 contact. The incidence of new illness compatible with Covid-19 did not differ significantly between participants receiving hydroxychloroquine (49 of 414 [11.8%]) and those receiving placebo (58 of 407 [14.3%]); the absolute difference was ?2.4 percentage points (95% confidence interval, ?7.0 to 2.2; P=0.35). Side effects were more common with hydroxychloroquine than with placebo (40.1% vs. 16.8%), but no serious adverse reactions were reported.
Ed George
June 3, 2020
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The Boulware study showed little effect of HCQ as a preventive of C19 for those closely exposed to another with virus. 12% of HCQ group came down with it to 14% for placebo. Zinc had no effect on outcome as a small group of participants used it.jerry
June 3, 2020
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Who to believe?
Sweden’s chief epidemiologist showed contrition Wednesday as criticism mounted over the Scandinavian country’s hotly debated method of fighting the coronavirus
or
Prof Lockdown’ Neil Ferguson admits Sweden used same science as UK but has suppressed coronavirus without tough restrictions
https://bit.ly/36ZorWu Of course Ferguson's opinions may be worthless. See discussion above on Sweden's extremely poor handling of elder care residents who make up about 70% of the deaths. They did worse than Cuomo and that's hard to imagine..jerry
June 3, 2020
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EG, there is enough data to show reasonable effectiveness. Note the results already given. KFkairosfocus
June 3, 2020
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After high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure. https://www.nejm.org/doi/full/10.1056/NEJMoa2016638?query=featured_home
Ed George
June 3, 2020
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U/D: After ferocious warnings against HCQ based on a -- flawed! -- Lancet study, WHO seems to be quietly resuming trials (which, on track record, will likely be set up to fail): https://www.msn.com/en-in/news/world/after-temporary-pause-who-to-resume-hydroxychloroquine-trials/ar-BB14Z85N >> After 'temporary pause', WHO to resume hydroxychloroquine trials wionnewsweb@gmail.com (Wion Web Team) 3 hours ago [share via email] Laboratory technicians sit next to boxes containing coronavirus disease (COVID-19) testing kits at a sample collection centre in Ahmedabad. (REUTERS) India lagging far behind on testing More than 26 lakh ration cards ‘unverified’ Tedros Adhanom Ghebreyesus wearing a suit and tie © Provided by WION World Health Organization(WHO) chief Tedros Adhanom Ghebreyesus said that after a "temporary pause" clinical trials of the drug hydroxychloroquine will resume.>> I will shortly add a screen capture of the WHO tweets at the linked, as demonstrated fact. I am going to bet that there was a roar of protest behind the scenes that was too strong to be dismissed. The implication of very carefully indirect words is that the sort of alleged leap in mortality suggested as due to HCQ is not solid enough to stand by the ferocious repudiation of a few days ago; so, there is an implicit climb-down. Wait for yet another study too far down the U. KFkairosfocus
June 3, 2020
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The Education Ministry announced that 2,000 more students and educational staff entered quarantined on Wednesady and 19 more have tested positive for the coronavirus, raising the total number of those quarantined to 6,831 and of confirmed cases to 244 amid an outbreak in schools in Israel. Additionally, due to the worsening situation, two more schools closed on Wednesday along with four others the same day, bringing the total number of schools shut so far to 42. (Shira Kadari-Ovadia) Update: high school in the Tel Aviv suburb of Givatayim has closed after an 11th grade student tested positive for the coronavirus. The student's mother was also diagnosed with COVID-19, and the student has been in quarantine for a week since his mother was diagnosed. Students and staff members who spent more than 15 minutes with the student who tested positive have been sent into isolation until June 7. The school will remain closed until students and staff complete two rounds of coronavirus testing, one to be carried out immediately and the other five days later. (Bar Peleg and Shira Kedari-Ovadia) https://www.haaretz.com/israel-news/.premium-coronavirus-israel-live-worker-in-netanyahu-s-office-diagnosed-with-covid-19-1.8888326rhampton7
June 3, 2020
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Sweden’s chief epidemiologist showed contrition Wednesday as criticism mounted over the Scandinavian country’s hotly debated method of fighting the coronavirus, which has resulted in one of the highest death rates per capita in the world. “If we were to encounter the same disease again, knowing precisely what we know about it today, I think we would settle on doing something in between what Sweden did and what the rest of the world has done,” said Tegnell, considered the architect of the unique Swedish pandemic approach. Asked if the country’s high death toll has made him reconsider his unique approach to the pandemic, Tegnell answered “yes, absolutely.” https://www.arabnews.com/node/1684201/worldrhampton7
June 3, 2020
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Hydroxychloroquine is not effective in preventing the development of COVID-19 in people exposed to the novel coronavirus, a new study involving Canadian researchers concludes. The results are published today in the New England Journal of Medicine. The clinical trial was led in Canada by Dr. Todd Lee and Dr. Emily McDonald of the Research Institute of the McGill University Health Centre, in conjunction with partners at the University of Manitoba and University of Alberta. “ We conducted an international, randomized controlled trial to look at whether the use of hydroxychloroquine in patients who'd had a high-risk exposure to COVID-19 would prevent the development of symptomatic disease compared to placebo," Lee said in an interview. Participants were recruited from Quebec, Manitoba, Alberta and across the United States. In total, the study involved 821 asymptomatic adults who had been exposed at home or in the health-care setting to someone with COVID-19. https://www.airdrietoday.com/national-news/hydroxychloroquine-does-not-prevent-covid-after-exposure-to-the-virus-study-2406921rhampton7
June 3, 2020
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The average patient who received hydroxychloroquine for a rheumatic disease was unlikely to achieve the total serum or plasma concentration necessary to inhibit the coronavirus in vitro, particularly at dosages of less than 400 mg per day, according to data published in The Journal of Rheumatology. “Our study addressed the important and unanswered question: Do patients with rheumatic disease already taking HCQ long-term achieve levels of the medication that have been shown to inhibit SARS-CoV-2 in vitro?” “ Our data suggest that patients with rheumatic disease are unable to safely obtain the plasma HCQ levels needed to completely inhibit SARS-CoV-2 based on the in vitro studies, indicating that HCQ is unlikely to be effective in the setting of SARS-CoV-2 viremia,” Balevic said. “While it is possible that patients achieve significantly higher HCQ levels in the lung tissue, animal studies suggest several months of treatment is necessary to reach peak tissue concentrations.” “Therefore, we should interpret the results of current clinical trials for HCQ and COVID-19 separately in the context of whether dosing was short term vs. long-term,” he added. “Ultimately, we highlight the need for high-quality clinical trial data to clarify HCQ's effectiveness, safety, and goal concentrations in the target tissue for SARS-CoV-2 before any specific dosage adjustments can be recommended.“ https://www.healio.com/news/rheumatology/20200602/longterm-hydroxychloroquine-use-for-rheumatic-disease-unlikely-to-prevent-covid19rhampton7
June 3, 2020
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University of Minnesota Medical School researchers have published results from a study which determine that hydroxychloroquine is not able to prevent symptoms of COVID-19. The University of Minnesota’s study, which was published in the New England Journal of Medicine, determined approximately 12% of those given the drug developed COVID-19 symptoms, compared to 14% in those given the vitamin placebo. The statistical difference, they said, was nonexistent; it would equate to treating 42 people with hydroxychloroquine in order to prevent one infection. Additionally, 40% of participants who took hydroxychloroquine developed side-effects: nausea, an upset stomach, or diarrhea. But the participants did not develop cardiac complications or other serious side-effects. https://minnesota.cbslocal.com/2020/06/03/u-of-m-researchers-determine-hydroxychloroquine-does-not-prevent-covid-19/rhampton7
June 3, 2020
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you were suggesting that the Swedish approach might have been correct, other than how they had dealt with care homes.
You use two qualifying words, "suggesting" and "might". Which means that I wasn't making an absolute claim. Which I wasn't. So why imply that I was. We don't know if it was better or not because we do not know the alternative effects which are not captured in the numbers of deaths. There are two major alternative effects that are unknown at this point in time. The number of future deaths because the population has not been exposed and the problems with the economic effects of the shutdown. Neither of which you addressed and I did. I just was pointing out that you cannot compare the two because they are extremely different situations. Now if I said
the Swedish approach was the correct approach, especially if they dealt effectively with care homes.
you might have a point but this statement could still be absolutely correct and you don't know if it is or isn't. No one does. Now if you want to know what I believe is the best approach. It is Open up the economy as normal and treat all potential cases early (with effective treatments) especially the elderly. I posted a couple times to an effective strategy for opening up the US by Dr. Todaro who estimates the death rate will be .03 percent or less. So I am arguing for the Swedish approach with effective treatment. The Swedes did not do any effective treatment and still their death rate is not as great as most of Europe.jerry
June 2, 2020
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Jerry - you were suggesting that the Swedish approach might have been correct, other than how they had dealt with care homes. But if you compare it with its neighbours (which are also similar culturally), the deaths are so much larger that it's unlikely that the difference is due to care homes.
Comparing it to Norway may be useful or it may be not because the two countries took different strategies. I believe Norway locked down a lot more than Sweden.
Yes, we did. Which is almost certainly why we have so many fewer deaths.Bob O'H
June 2, 2020
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PS: I have no clue how to hyper link in this comment
How much HTML do you know? If you know basic coding, the go to the internet and look up embedding a link in text. It will then allow you to do it here except the code will place some extraneous code in the HTML automatically.jerry
June 2, 2020
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So unless over 90% of the Swedish deaths have been in care homes, they will still have had more deaths outside of that population than Norway has.
I have no idea what your point is. I provided an estimate of the percentage of deaths that were in care homes. I also never said it. was equivalent to Norway. But it is interesting that it is not has high as many of the countries in Europe that shut down. And would it be even lower if they took good care of their elderly which is my point. Also an alternative hypothesis suppose the elderly deaths in care homes was the same rate as the rest of the world. This means that the death rate in the non elderly population is much less than most of those countries that shut down. Also apparently the rate of deaths in Stockholm is much higher than the rest of Sweden. Comparing it to Norway may be useful or it may be not because the two countries took different strategies. I believe Norway locked down a lot more than Sweden. In the United States there were 51 different strategies. Since you live in Norway, why don't you describe what they did. Also do you expect the strategy Norway used is applicable for the future. If people are not getting the virus as much in Norway will that be true once they open up or will they have to be closed indefinitely. Maybe you want to comment on what are the prospects of each strategy, opening up vs permanent lockdown.jerry
June 2, 2020
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According to statista, only 11% of death in Sweden is younger than 70 years old (4% for below 60). I think I read somewhere half of the elder live in care homes. https://www.statista.com/statistics/1107913/number-of-coronavirus-deaths-in-sweden-by-age-groups/ PS: I have no clue how to hyper link in this commentRavenT
June 2, 2020
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Is it possible that the Sweden model has been successful but medical care was extremely inadequate especially for the elderly.
They've had 436 deaths per million, whilst next door in Norway we've had 44 per million (data from Worldometers). So unless over 90% of the Swedish deaths have been in care homes, they will still have had more deaths outside of that population than Norway has. The only way I can see poor elderly care making a difference is if there is a massive spill-back into the general population.Bob O'H
June 2, 2020
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I have been looking through the plots in worldometers for daily new cases and the one fairly common trend is a very rapid initial increase to a peak followed a less steep But consistent decline. A few exceptions are Poland, Sweden and the US. These countries have extended plateaus or very gradual declines.Ed George
June 1, 2020
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An arthritis drug may be a life-saving coronavirus treatment and reduce the need for patients to be placed on ventilators, according to French doctors. The doctors administered anakinra, an anti-inflammatory drug normally used to treat rheumatoid arthritis, to 52 Covid-19 patients at the Saint-Joseph public hospital in Paris between March 24 and April 6 and compared their progress with that of 44 historical coronavirus patients at the hospital who were not treated with the drug. Thirteen (25 per cent) of the patients injected subcutaneously with anakinra either died or had to be placed on ventilators, compared with 32 patients (73 per cent) in the historical group. https://www.telegraph.co.uk/news/2020/06/01/arthritis-drug-may-aid-virus-fight-french-doctors-say/rhampton7
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